Page 58 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 3
gel in one group of 10 animals and icodextrin 4% in the others. The objective was to investigate if remnants of the anti-adhesives were microscopically visible in the abdominal wall after a longer period. Animals were sacrificed after four and six weeks and samples of the abdominal wall were taken for histological examination.
Measurements
Adhesion formation
After two weeks the animals were anaesthetised and the abdomen was opened by an incision through the midline. Two independent observers who were blinded for all groups scored adhesion formation macroscopically using a standardized scoring system. The previously created peritoneal wound was divided in eight segments by the three sutures and adhesions attached to one segment were scored as 12.5% of the total wound surface. Total adhesion formation was the sum of all areas to which adhesions were attached with a maximum of 100%. In each rat two lateral peritoneal sides were assessed.
For objective scoring of the severity of the adhesions the Zühlke scoring system was used [13]. This system has a four-degree classification of adhesions based on histological and morphological criteria (Table 1). Finally the animals were sacrificed by cardiac incision.
Table 1. Zühlke score: macroscopic classification of abdominal adhesions.
Zuhlke type 1
2
3 4
Pictures
Characteristics
Filmy adhesion, easy to separate by blunt dissection
Stronger adhesion; blunt dissection possible, partly sharp dissection necessary; beginning of vascularization
Stronger adhesion; lysis possible by sharp dissection only; clear vascularization
Very strong adhesion; lysis possible by sharp dissection only; organs strongly attached with severe adhesions; damage of organs hardly preventable
Photographs were taken of all procedures during the experiment with a 5.0 megapixels digital camera, Sony Cybershot.
56